Sedan början av 1900-talet har de flesta förlossningar skett på sjukhus och antalet hemförlossningar har minskat drastiskt. Idag är hemförlossningar ytterst ovanligt i Sverige och finns ej som ett vårdval trots att kvinnor har rätt till självbestämmande vad gäller sin graviditet och förlossning.  Syftet var att beskriva kvinnors anledningar till att välja hemförlossning.    En litteraturöversikt med ett systematiskt tillvägagångssätt utfördes som metod. Databassökning skedde i databaserna PubMed, CINAHL samt PsycInfo. Artiklarna kvalitetsgranskades och inkluderade artiklar analyserades med integrerad analys.   Studiens resultat mynnade ut i två huvudkategorier. Den första huvudkategorin var “på kvinnans egna villkor” med subkategorierna “egenmakt och kontroll”, “hemmet som en trygg plats”, “tron på den egna kroppen” och “den fysiologiska födseln” samt “val av närvarande personer”. Den andra huvudkategorin var “att undvika negativa upplevelser” med subkategorierna “tidigare negativa erfarenheter” och “viljan att undvika interventioner”.    Slutsatsen var att det finns olika anledningar till att kvinnor väljer hemförlossning där de främsta är att föda på sina egna villkor och önskan att undvika negativa upplevelser. Kvinnor vill ha inflytande över sin förlossning och ha möjlighet att välja personer som ska närvara och stödja kvinnan. Hon vill föda på en trygg och säker plats, hemmet, där hon har större möjlighet till en normal eller fysiologisk förlossning utan onödiga interventioner. För att främja kvinnors självbestämmande bör alternativ till sjukhusförlossning erbjudas. / Since the beginning of the twentieth century, the majority of births have taken place in hospitals, and the number of home births has decreased substantially. Home birth is utterly rare in Sweden, and it is not a publicly funded option for Swedish women, even though women should have the right to independently make decisions about their pregnancy and labor.   The aim of the study was to describe women’s reasons for choosing home birth.  A literature review with a systematic approach was the performed method. Databases used for this purpose were PubMed, CINAHL and PsycInfo. The articles were quality reviewed and analyzed through integrated analysis.    The findings of the study were presented in two main categories with appurtenant subcategories. The first main category was “the woman’s own terms” with subcategories “empowerment and control”, “the home environment is a safe space”, “belief in the body and the physiologic birth” and “choosing present people”. The second main category was “wanting to avoid negative experiences” with subcategories “previous negative experiences” and “wanting to avoid interventions”.  The conclusion was that there are various reasons why women choose home birth where the main reasons were to give birth on their own terms and a desire to avoid negative experiences. Women want to be able to influence their labor and have the opportunity to choose people who will be present and support the woman. She wants to give birth in a safe and secure place, her home, where she has a better chance for a normal and physiological birth without unnecessary interventions. In order to promote women's self-determination, alternatives to hospital birth should be offered.

This research examined two interrelated issues relevant to maternal and neonatal health in Pakistan, namely, the rising rates of C-section delivery and low rates of exclusive breastfeeding. By using the Andersen's health behavioral model to frame two empirical studies, the data from the Pakistan Demographic and Health Survey (PDHS) 2012-13 was used. The first empirical study examined the correlation between place of delivery and the odds of cesarean section in Pakistan. Not all Pakistani women have an equal chance of delivering at a health facility where C-section delivery takes place; therefore, the study modeled mode of delivery as a two-step process. In the first step, place of delivery was a function of medical indications and various sociodemographic and community factors. Women who delivered at a health facility were included in the second step, where C-section was a function of medical indications and type of facility (private, public). It is found that women who delivered at a private health facility were more likely to have a C-section, even after controlling for the effects of medical/clinical factors, which is concerning. Findings suggest that the private maternal health sector in Pakistan may be over-medicalizing childbirth. The second study examined this paradox of low exclusive breastfeeding in Pakistan, taking into account not only individual-level characteristics of the child and parents, but also place and mode of delivery, sociocultural factors, and community composition. The sample consisted of 1,044 children 0-5 months old, currently living with their mothers. Binary logistic regressions of exclusive and predominant breastfeeding found women who delivered vaginally, whether at home or health care facility were more likely than mothers who delivered via C-section to predominantly breastfeed their infant, and that mothers who delivered vaginally at a health care facility were more likely than their peers who delivered via C-section to exclusively breastfeed their infants. Collectively, the findings of both empirical studies suggest that private maternal health care services in Pakistan may be facilitating medically unnecessary C-sections, either for profit making or time management. An extended and integrated policy regarding medically unnecessary C-section delivery and low rates of exclusive breastfeeding is needed in Pakistan to address both issues together effectively.

The mechanical function of the uterine cervix is critical for a healthy pregnancy. During pregnancy, the cervix undergoes a significant remodeling from a mechanical barrier into a compliant structure to allow for a successful delivery. A too early or too late cervical softening will lead to spontaneous preterm births (sPTB) or dystocia. PTB is a leading cause of neonatal death, affecting 15 million newly born babies each year around the world. According to CDC, the rate of PTB increases in recent years. Dystocia increases the risk to both mother and newborn babies, leading to neonatal asphyxia, neonatal infection, uterine rupture, or other dangerous sequelae. Therefore, it is significant to have a better correlation of the mechanical properties change and the biological remodeling process of the cervix during pregnancy. This thesis will focus on (1) mechanical experiments of the human cervix, and (2) the development of a material constitutive model for cervix to characterize the complex microstructure-related mechanical property of the cervix. In this thesis, a spherical indentation test was designed and conducted on human cervical samples sliced perpendicular to the axial direction, to characterize the compressive mechanical behavior of the human cervix. A uniaxial tensile was designed and conducted on the strip samples cut along and perpendicular to the preferential fiber direction from the indentation samples, to characterize the tensile mechanical behavior of the cervix. Based on the detailed experimental investigation, a nonlinear time-dependent anisotropic microstructure-inspired constitutive model has been developed. The basic idea of the model is that the mechanical behavior of the human cervix can be decomposed into an equilibrium and a time-dependent part, and the tension and compression mechanical behaviors are caused by disparate mechanisms. Specifically, the collagen fibrous network plays a major role in the tensile mechanical response, while proteoglycans (PGs), glycosaminoglycans (PGs),, and liquid cause the compressive mechanical response. The tensile time-dependent mechanical behavior of the human cervix is mostly attributed to the interactions between the collagen fiber and other components, while the compressive time-dependent mechanical behavior is mainly attributed to the porous effect. The equilibrium and time-dependent mechanical responses have been well captured using the model, and the results reveal the connection between the ECM microstructure remodeling and mechanical properties change during pregnancy.

Rosary devotion has long been considered a "female-centered" religious practice. Despite this correlation, no scholars have investigated the relationship between women and the rosary. In this thesis I attempt to fill that void by examining a range of meanings the rosary held for laywomen in late fifteenth- and early sixteenth-century Northern Europe, c. 1470 to c. 1530. Using a theoretical framework informed by materialism, gender theory, and Marian theory, my thesis argues that beyond its usual associations with indulgences, the rosary also signified prayers for conception and safe childbirth. In reciting prayers to the Madonna, laywomen spiritually and mystically projected themselves into the narrative of the Virgin's pregnancy, desiring to bear a child as Mary bore Christ.To explicate the relationship between women and the rosary, my thesis considers a variety of rosary images: female donors with their prayer beads, Andachtsbilder portraying the Christ Child holding and playing with a string of beads, images of the Holy Kinship, instructive prints from rosary manuals, and early family portrait scenes. As a whole, these images suggest that the rosary symbolized a budding womb, a wife's ideal piety, the desire for children, the maternal qualities of the Virgin, and an amulet to assuage the rigor of childbirth. Lastly, my thesis considers the rosary as religious jewelry. By looking to several examples of women depicted with ornate rosaries, my thesis argues that laywomen wore beads to elevate their status and to emulate the aristocracy. Moreover, wearing rosaries and/or being painted with one's rosary allowed for a public pronouncement of one's private piety. For women, then, wearing a rosary was another way in which they could enter into the public devotional realm. In arguing that the rosary was perceived by women as a blossoming vine, as a piece of religious jewelry, and as an aid in childbirth, I hope to have contributed new ways of understanding this multivalent devotional tool, and to have opened new avenues for others to consider the rosary beyond its usual associations with prayer counting and indulgences.

No description available.

Females of childbearing age are overrepresented in the population of the Kellis 2 cemetery (100-450 AD) in the Dakhleh Oasis, Egypt (Wheeler 2009). The demographic overrepresentation found here may be the result of complications related to childbirth. Clinical literature demonstrates that fetal size is rarely an explanation for failed labor (Cunningham et al. 2001) and the fetuses buried in the Kellis 2 Cemetery at the Dakhleh Oasis were not larger than average (Tocheri et al. 2005), directing the focus to dimensions of the maternal pelvis for evidence of obstetrical issues, such as abnormally compressed pelvises. To formulate a test for this hypothesis, a total of 50 adults, 24 of which are female, were examined for this study. The sample consisted of individuals from an archaeological population from the Dakhleh Oasis, Egypt as well as from six populations housed in the American Museum of Natural History (NYC). These include archaeological populations from the sites of El Hesa and Sai Island in the Sudan, also South Africa, Nubia, and India, as well as a medical collection from North America. Pelvic dimension and asymmetry was determined through nine measurements of the pelvis and sacrum. Kruskal-Wallis tests were used to analyze variance and assess whether the younger females in this group may have been at a higher risk of death during childbirth due to fetal-pelvic disproportion. Mann-Whitney-Wilcoxan nonparametric tests were used to assess differences in asymmetry in young and old groups. A MANOVA test assessed overall variation in the population. Results indicate significant differences between young and old females in pelvic outlet anteroposterior diameter, a measure of midpelvic contraction, as young females had smaller pelvic outlet anteroposterior diameters. There were also significant differences between iv young and old females in alar-pubis length asymmetry; the young females were more asymmetric. These differences were not found in the male groups. It is suggested that these differences could impact childbirth as a contracted midpelvis, such as that found in the young female group, can cause transverse arrest of the fetal head (Cunningham et al. 2010) and pelvic asymmetry can contribute to obstetrical complications (Campbell et al. 2011).

Bakgrund Sedan förlossningsvården ändrat sina riktlinjer kring induktion har induktionerna i Sverige ökat. Detta innebär att allt fler kvinnor genomgår behandlingar under sin förlossning som kan vara påfrestande för dem. Tidigare forskning har visat att kvinnors upplevelser av delaktighet och stöd är viktiga faktorer för en positiv förlossningsupplevelse. Kunskap om kvinnors upplevelser av induktion kan ge barnmorskan bättre förutsättningar att stödja dessa kvinnor till en positiv förlossningsupplevelse. Syfte Syftet var att beskriva kvinnors upplevelser av induktion vid fullgången graviditet. Metod En litteraturöversikt med systematisk metod utfördes. Artikelsökning utfördes i databaserna Pubmed och CINAHL, där 16 artiklar valdes ut till resultatet. För att säkerställa kvalitén på de valda artiklarna användes en kvalitetsmatris för granskning av artiklarna. En Integrerad analysmetod har tillämpades för att sammanställa resultat. Resultat Fyra huvudkategorier som representerade kvinnors upplevelser av induktion framkom. Dessa var; Information, En ny resa, Beslutsprocessen och Förlossningsupplevelsen. Inom dessa kategorier framkom underkategorier; Att ställa om, En känsla av lättnad, Varierande upplevelser av information, Information relaterat till riskerna, Delaktighet och Ett beslut färgat av andras bedömningar och en rädsla att skada barnet. Slutsats Kvinnors upplevelser av induktion är varierande och trots att de kan uppleva induktionens olika delar som påfrestande, så har de förmågan att ställa om och hitta fördelar med induktionen. De delar av induktionen som upplevs som mest otillfredsställande hos kvinnor kan kopplas till information och delaktighet. Barnmorskans roll är av stor vikt när det kommer till att stödja kvinnor som genomgår induktion. Genom att stärka deras upplevelse av delaktighet, både under beslutsprocessen och förlossningen, kan barnmorskan bidra till en positiv förlossningsupplevelse hos dessa kvinnor. / Background The number of inductions in Sweden has increased since the maternity ward have changed their guidelines regarding this procedure. This means that more and more women are undergoing treatments during their childbirth that can be stressful for them. Previous research has shown that women's experiences of participation and support are important factors for a positive birth experience. Knowledge of women's experiences of induction can give the midwife better conditions to support these women to a positive birth experience. Purpose The purpose was to describe women's experiences of induction at full term pregnancy. Method A literature review using a systematic method was performed. Article searches were conducted in the databases Pubmed and CINAHL, where 16 articles were selected as the result. To ensure the quality of the selected articles, a quality matrix was used to review the articles. An integrated analysis method has been applied to compile results. Results Four main categories representing women's experiences of induction emerged. These were; Information, A new journey, The decision process and The birth experience. Within these categories, subcategories emerged; Changing, A feeling of relief, Varying experiences of information, Information related to the risks, Participation and A decision colored by the judgments of others and a fear of harming the child. Conclusion It is common for women to feel that something is lost with the induction, but they have an ability to readjust and find meaning in the new. With clear and comprehensive information, women's experiences of participation increase both during the decision-making process and during childbirth. Women can experience the induction as stressful, but through participation and support from the midwife, the birth experience can be positive.

Bakgrund: Utöver information från barnmorska, offentliga diskussioner samt samtal med släkt och vänner söker de flesta kvinnorna information om smärtlindring på sociala media om val av smärtlindring under förlossningen. Flertalet kvinnor vill använda någon typ av smärtlindring och förväntar sig att själva välja.   Syfte: Syftet var att belysa föderskors upplevelse av att ej blivit lyssnade på i val av smärtlindring under sin förlossning. Metod: Netnografisk metod användes. Författaren verkade som dold observatör på två internettbaserade forum. Inläggen som användes i studien var skrivna av anonyma deltagare. Kozinets (2015) dataanalysmodell användes för att analysera resultatet. Resultat: Kvinnor i forumen upplevde att de inte fått föra sin talan angående val av smärtlindring under förlossningen. Barnmorskor hade tagit beslut utan förklaring till varför och utan deras medgivande. Kvinnor kunde både känna sig nekade och påtvingade smärtlindring. De berättade om situationer då sjukvårdspersonalen inte bemött dem på ett professionellt sätt, vilket ledde till en negativ förlossningsupplevelse. Slutsats: Det är av stor vikt att kvinnan får föra sin talan under förlossningen. Rätten om självbestämmande ska följas och smärtlindringen behöver anpassas personligen till varje kvinna. Detta för att skapa god förlossningsvård. Mer kunskap inom ämnet obstetriskt våld behövs så att det ej uppstår. / Background: In addition to information from midwives, public discussions and conversations with family and friends, most women seek information about pain relief on social media about choosing pain relief during childbirth. Most women want to use some type of pain relief and expect to choose for themselves. Aim: The aim of the study has been to highlight the experience of not being listened to regarding choice of pain relief when giving birth. Method: A netnographic study was used. The author acted as an observer and conducted a hidden study on two internet-based forums. The posts that were used in the study was written by anonymous participants. Kozinets (2015) data analysis model was used to analyse the result. Outcome: The women in the forums experienced that they were not able to speak for themselves regarding their choice of pain relief when giving birth. The midwives had already made the decision without any explanations or consent from the women. The women could feel that pain relief was forced on them or that it was denied. They told stories about situations where the health care  personal  had not treated them in a professional way, which led to a negative birthing experience. Conclusions: It is of great importance that the women can speak for themselves during the childbirth. The right to decide for oneself shall be respected, and the choice of pain relief needs to be individually adapted for each woman. This is to create a good obstetric care for women. More knowledge regarding obstetric violence is needed so that the health care can prevent this from occurring.

Bakgrund: Transman är en person född som kvinna juridiskt men som identifierar sig som man. Transmän ären specifik grupp med egna behov. Transmän upplever ofta könsdysfori som innebär ett obehag som uppstårnär den upplevda könsidentiteten inte överensstämmer med den biologiska könsidentiteten. För att dämpa könsdysforin krävs ofta könsbekräftande behandling så som hormoner och kirurgi. Behovet av att bilda familj finns i samma utsträckning som hos cispersoner. Syfte: Syftet med den kvalitativa metasyntesen var att undersöka transmäns upplevelser av graviditet, förlossning och postpartumperioden samt hur de upplever vårdmöten inom dessa områden. Metod: Kvalitativ metasyntes med meta-ethnografi som analysmetod. Datainsamling har utförts i databaserna Cinahl, PubMed, Summon, Psychinfo samt Web of sience. I metasyntesens resultat ingår 11 artiklar. Resultat: Fyra huvudteman: Graviditet, Förlossning, Postpartumperiod och Vårdmöten. I dessa ingår åtta underteman: Nödvändigt, Tillhörighet, Ensamhet, Rädsla, Oro, ”Chestfeeding”, Transfobi och Könsbekräftelse. Slutsats: Transmäns upplevelser av graviditet, förlossning och postpartumperioden samt vid vårdmöten varierade. Upplevelserna var både positiva och negativa, men till största del negativa. Vid graviditeten beskrevs en öka könsdysfori vilket ledde till ensamhet. Det fanns en oro under förlossning att exponera sia genitalier samt att utsättas för transfobi. Under postpartumperioden var upplevelserna bröstrelaterade och ”chestfeeding” en central faktor. Under vårdmöten speglades upplevelserna av hur pronomen och tilltalsnamn benämndes. Klinisk tillämpbarhet: Resultatet kan användas för att öka barnmorskors kunskap avseende transmäns upplevelser av graviditet, förlossning och postpartumperioden samt hur transmän vill bli bemötta i vården under dessa perioder. Kunskapen kan ge barnmorskor en bredare insikt angående könsdefinitioner och könsnormer. / Background: Transman is a person born as a woman legally but who identifies as a man. Transmen are a specific group with their own needs. Transgender people often experience gender dysphoria, which means a discomfort that arises when the perceived gender identity does not correspond to the biological gender identity. To alleviate gender dysphoria, gender-confirming treatment such as hormones and surgery are often required. The need to start a family exists to the same extent as in cis persons. Aim: The aim of the qualitative metasynthesis was to investigate trans men's experiences of pregnancy, childbirth and the postpartum period and how they experience care encounters in these areas. Method: Qualitative meta-synthesis with meta-ethnography as analysis method. Data collection has been performed in the databases Cinahl, PubMed, Summon, Psychinfo and Web of science. The results of the meta-synthesis include 11 articles. Results: Four main themes:Pregnancy, Childbirth, Postpartum Period and Care Meetings. These include eight sub-themes: Necessary, Belonging, Loneliness, Fear, Anxiety, "Chestfeeding", Transphobia and Gender Confirmation. Conclusion: Transmen's experiences of pregnancy, childbirth and the postpartum period as well as at care meetings varied. The experiences were both positive and negative, but mostly negative. During pregnancy, an increase in genderdysphoria was described, which led to loneliness. There was a concern during childbirth to expose genitals and to be exposed to transphobia. During the postpartum period, the experiences were breast-related and "chestfeeding" was a central factor. During care meetings, the experiences were reflected in how pronouns and first names were named. Clinical applicability: The results can be used to increase midwives' knowledge regarding trans men's experiences of pregnancy, childbirth and the postpartum period and how transmen want to be treated in care during these periods. The knowledge can give midwives a broader insight regarding gender definitions and gender norms.

Kvinnors känslor inför en graviditet och förlossning kan variera. Alltifrån glädje till ångest och rädsla kan upplevas . För vissa kvinnor kan känslor som ångest och rädsla vara så starka att förlossningsrädsla utvecklas. Förlossningsrädsla kan vara primär eller sekundär. En primär förlossningsrädsla kan orsakas av förlossningsberättelser från omgivningen som bidrar till att en förstföderska utvecklar en rädsla. En sekundär förlossningsrädsla kan bero på tidigare negativa förlossningsupplevelser hos en omföderska. Förekomsten av förlossningsrädsla i Sverige är högre hos omföderskor, 15,2 procent svarar att de upplevt förlossningsrädsla. Detta kan jämföras med förstföderskor där 14,6 procent ger samma svar. En barnmorska bör tillgodose kvinnans behov, möjliggöra upplevelsen av kontroll samt skapa en förtroendeingivande relation med den förlossningsrädda kvinnan. Syftet med denna litteraturöversikt var att belysa förlossningsrädda kvinnors erfarenhet av barnmorskans stöd under graviditet och förlossning. Vald metod är en allmän litteraturöversikt med kvalitativ ansats. Samtliga artiklar som inkluderats i resultatet var baserat på intervjuer med kvinnor som lider av förlossningsrädsla. Vidare analyserades samtliga artiklar med kvalitativ innehållsanalys. Utifrån genomförd analys identifierades tre kategorier med tillhörande underkategorier. De tre kategorierna är ”Relationens betydelse vid förlossningsrädsla”, ”Att tillgodose kvinnans önskemål” och ”Att ge rätt stöd minskar förlossningsrädsla”. Kategorin ”Relationens betydelse vid förlossningsrädsla” beskriver vikten av barnmorskans tillgänglighet och närvaro under en förlossning som viktig för många kvinnor. Känslor som att känna sig säker, väl omhändertagen och bekräftad var exempel på positiva känslor som kvinnor upplevt genom att ha en närvarande barnmorska. Om en förtroendeingivande relation skapats mellan barnmorskan och kvinnan ökade möjligheten för en positiv förlossningsupplevelse. Underkategorin ”Att tillgodose kvinnans önskemål” berörde kvinnans önskemål om att få hantera sin rädsla i ett tidigt skede samt önskan om att få bli inkluderad i beslut. Den sista kategorin ”Att ge rätt stöd minskar förlossningsrädsla” berörde individuellt, psykiskt och fysiskt stöd som visade sig ha en positiv inverkan och minskade förlossningsrädslan. Slutsatsen av detta arbete är att barnmorskans stöd är av största vikt för att bemöta förlossningsrädsla. Om en barnmorska ger rätt stöd så som individanpassad rådgivning kan det leda till känslor av säkerhet, mindre önskan om kejsarsnitt utan medicinsk indikation samt en ökad möjlighet att kvinnan får en positiv förlossningsupplevelse. Stöd från barnmorskan kan således ha en betydelse för hur kvinnan hanterar sin förlossningsrädsla. / Women's thoughts and emotions regarding pregnancy and childbirth may differ from pure joy to anxiety and fear. For some women, feelings like anxiety or fear can grow very strong and thus develop into a condition called fear of childbirth. This condition can be both primary and secondary. Primary fear of childbirth is often the result of stories from the woman ́s surroundings while secondary fear of childbirth can stem from earlier negative experiences with childbirth. The prevalence of fear of childbirth has been shown to be greater among women during their second pregnancy where 15,2 percent experienced this condition. Among women expecting their first child, the number is somewhat lower at 14,6 percent. A midwife should see the needs of the mother to be, impart a sense of control and create a relationship with the pregnant woman based on trust. The purpose of this literature review has been to illustrate how support from midwives affects pregnant women who suffer from fear of childbirth - both during the pregnancy and actual childbirth. Our chosen method has been a literature review with a qualitative approach. All articles included in the result of this study have been based on interviews with mothers who have first-hand experience of fear of childbirth. Furthermore, these same articles were analyzed with a content analysis using a qualitative approach. Based on this study - we identified three categories with subcategories pertaining to the result. These were: “The meaning of a trustful relationship in case of fear of childbirth”, ”To satisfy the woman's wishes” and “Correct support decreases the fear of childbirth”. The category “The meaning of a trustful relationship in case of fear of childbirth” showed that the presence - and accessibility - of the midwife were important factors for many women. These women expressed feelings of security, acknowledgment, and the sense that they were taken care of. In cases where a relationship based on trust and confidence formed between the woman and the midwife - the chances of having a positive experience of childbirth increased. The second category “ To satisfy the woman's wishes” investigates the effects of dealing with fear at an early stage and including the woman in the decision-making process. The last category “Correct support decreases the fear of childbirth” touched on individual, psychological and physical support that has been shown to have a positive impact on the fear of childbirth. This essay concludes that the support that midwives can give is of the utmost importance when dealing with the fear of childbirth. If a midwife is able to give support such as individual counseling - this can then lead to the woman feeling more secure and less prone to asking for a cesarean section without a purely medical reason. This - in turn - can lead to a more positive experience of childbirth. The support of midwives can thus have a significant effect on how women deal with fear of childbirth.